tbuckley/cabot-search huggingface dataset:
Abstract 14158: Impact of Gender Differences on Changes in Myocardial Perfusion Following Percutaneous Coronary Intervention of Chronic Total Coronary Occlusions
Authors: Yvemarie Somsen, Ruben de Winter, Anna van Veelen, Stefan Schumacher, Pepijn van Diemen, Ruurt Jukema, Roel Hoek, Wynand Stuijfzand, Ibrahim Danad, Niels Verouden, Nap Alexander, Jose P Henriques, Paul Knaapen
Journal: Circulation (2022)

Introduction. Data on gender differences in chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) are scarce. Prior studies have demonstrated CTO PCI to reduce ischemia, however female patients are less likely to undergo revascularization. This study sought to investigate the impact of gender on myocardial perfusion changes following CTO PCI as measured by [ 15 O]H 2 O positon-emission tomography (PET) perfusion imaging. Methods. A total of 212 patients were prospectively enrolled in a single-center CTO registry and underwent single-vessel CTO PCI, combined with [ 15 O]H 2 O PET imaging at baseline and three months follow-up. Baseline and follow-up resting myocardial blood flow (MBF), hyperemic MBF and coronary flow reserve (CFR) allocated to the CTO territory were quantitatively assessed. The presence of residual ischemia was defined as hMBF ≤2.3 mL·min -1 ·g -1 in the CTO area at follow-up. Results. This study comprised 34 (16%) females and (84%) males. Mean age in females was higher compared to males (68 ± 9 vs. 61 ± 10 years, p&lt;0.01). In women, resting MBF at baseline was more elevated than in men (1.02 ± 0.24 vs. 0.84 ± 0.21 mL·min -1 ·g -1 , p&lt;0.01). Similarly, baseline hMBF was found to be higher in females (1.81 ± 0.53 vs. 1.64 ± 0.53 mL·min -1 ·g -1 , p=0.03), and showed a higher increase after CTO PCI (Δ1.06 ± 0.71 vs. Δ0.71 ± 0.66 mL·min -1 ·g -1 , p=0.01). Improvement in CFR after CTO PCI was more evident in female patients (Δ1.17 ± 1.04 vs. Δ0.82 ± 0.89, p=0.04). At three months follow-up, the proportion of patients with residual ischemia was lower in women versus men (9 (27%) vs. 91 (51%), p=0.01). Conclusions. We found a higher increase in hyperemic MBF and CFR following CTO PCI in women compared to men, as measured by serial [ 15 O]H 2 O PET imaging. In addition, lower rates of residual ischemia were observed in women. This study suggests the potential benefit of a lower threshold for CTO PCI in female patients.
Abstract 12906: Exercise Training Protects Against Ischemic Muscle Damage in a Large-Animal Model of Peripheral Artery Disease
Authors: Emma Fletcher, Ahmed Ismaeel, Evlampia Papoutsi, Feifei Li, Carson Hoffmann, Maiko Sasaki, Joseph Zarge, Luke P Brewster, Panagiotis Koutakis
Journal: Circulation (2022)

Peripheral artery disease (PAD) causes an ischemic myopathy in the lower extremity muscles, which contributes to patient functional disability. Although structured exercise therapy is a leading therapeutic to improve ambulatory function, the impact of exercise on PAD myopathy is unclear. Using our porcine model of PAD, we sought to elucidate the effect of hindlimb ischemia on markers of 1) muscle damage (caspase 3, myogenic differentiation 1 (MyoD), and Forkhead box protein O1 (FOXO1)), 2) muscle protein turnover (autophagic flux and proteolytic activity), and 3) whether these indices were altered with exercise training. Methods: Seven Yorkshire swine were exposed to right hindlimb ischemia by endovascular external iliac artery occlusion. Following ischemia onset, the swine were divided into 2 training groups: supervised exercise trained (ET) (n=4) and sedentary controls (SED) (n=3). ET pigs followed an incremental treadmill protocol 3 times weekly for 4 weeks. SED pigs had standard ambulation. The tibialis anterior from ischemic and non-ischemic limbs was excised after animal termination. Markers of muscle damage and proteolytic activity were assessed via RT-PCR and enzymatic activity kits, respectively. The ratio of intramuscular microtubule-associated protein light chain 3 (LC3)-II:LC3-I, as well as sequestosome (p62), and mitofusion2 (MFN2) content from immunoblots were used to monitor autophagic flux. Results: Gene expression of intramuscular damage was significantly higher in SED ischemic muscle compared to ET muscle (caspase 3 (SED: 5.59±1.5; ET: 1.67±1.5), MyoD (SED: 4.55±1.2; ET: 1.24±1.5) and FOXO1 (SED: 1.74±0.5; ET: 1.07±1.1), p&lt;0.0001). Moreover, ischemic muscle from ET pigs showed no alteration in markers of muscle damage when compared to the SED and ET non-ischemic conditions (p&gt;0.05). Although proteolytic activity was unaltered (p&gt;0.05), autophagic flux tended to be increased in ET ischemic muscle (LC3-II:LC3-I ratio (ET: 0.21±0.1; SED: 0.10±0.1 AU, p=0.099), p62 (ET: 15.80±5.1; SED: 7.75±2.8 AU, p=0.068) and MFN2 (ET: 42.72±15.9; SED: 16.82±11.3 AU, p=0.214). Conclusions: These data suggest exercise therapy is protective against ischemic muscle damage and may improve muscle quality via accelerating autophagic flux.
Abstract 12983: Diagnostic Performance of an Automated Blood Pressure Monitor With an Irregular Heartbeat Algorithm Designed to Detect Atrial Fibrillation
Authors: Makoto Ishizawa, Tetsuo Minamino, Yu Ishihara
Journal: Circulation (2022)

Introduction: Patients with atrial fibrillation (AF) are constantly exposed to the risk of developing stroke, and early detection to initiate appropriate treatment for AF is important to prolong their healthy life. In previous reports, automated blood pressure (BP) monitors manufactured by A&amp;D Co., Ltd. was equipped with an irregular heartbeat (IHB) algorithm specifically designed to detect AF, suggesting its usefulness for AF monitoring in hypertensive patients with a high prevalence of AF. Purpose: The aim of this study was to evaluate the diagnostic performance for AF of the A&amp;D BP monitor UM-212 with an IHB algorithm in a clinical setting. Methods: A total of 242 consecutive patients was enrolled (mean age: 67.5 years, 62.3% male). BP measurements were performed three times per one patient using UM-212 and the presence or absence of IHB detection was recorded for each measurement. The definition of IHB algorithm designed to detect AF is as follows: the number of pulse waves varying more than 15% from the mean of the pulse peak interval is greater than 20% of the total pulse wave count. A 3ch real-time ECG was recorded during all BP measurements. The interpretation by automated ECG analysis software manufactured by Fukuda Denshi Co., Ltd. and the final ECG diagnosis by two cardiologists were performed separately. Results: Of the 242 patients, 31 had AF and 66 had non-AF arrhythmia. On a per-measurement basis (726 total), IHB detection had 98.9% of sensitivity and 90.7% of specificity for diagnosing AF. Under the same condition, ECG analysis software had 90.3% of sensitivity and 96.5% of specificity for diagnosing AF. On a per-patient basis, IHB detection in all three BP measurements had 96.8% of sensitivity and 95.7% of specificity for diagnosing AF. Under the same condition, ECG analysis software had 80.6% of sensitivity and 99.1% of specificity for diagnosing AF. Conclusions: The IHB algorithm designed to detect AF built into A&amp;D BP monitors showed high sensitivity and high specificity for diagnosing AF in a clinical setting, especially its sensitivity tended to exceed that of automated ECG analysis software. Utilizing the IHB algorithm during routine BP measurements is expected to monitor AF in hypertensive patients and contribute to their health management.
Abstract 13458: Sudden Cardiac Arrest in Dialysis Patients: A Community-Based Study
Authors: Audrey Uy-Evanado, Kyndaron Reinier, Harpriya Chugh, Chad Sorenson, Jonathan Jui, Sumeet S Chugh
Journal: Circulation (2022)

Introduction: Individuals with end-stage renal disease (ESRD) on hemodialysis (HD) may be at increased risk of sudden cardiac arrest (SCA) during dialysis. However, existing studies are small and there is a lack of population-based data. Hypothesis: Patients on dialysis are overrepresented among SCAs occurring in the general population. Methods: From the prospective Oregon Sudden Unexpected Death Study, all cases of SCA were ascertained (2002-2017). For each individual, detailed medical history was obtained from hospital records and first responder reports, also capturing patients with history of dialysis. Cases who suffered SCA during dialysis sessions or within an hour after completing dialysis (on-dialysis group) were compared to cases who had SCA at other times (off-dialyses group). We used chi-square and t- tests to compare the two groups. Results: A total of 4880 SCA cases with clinical data available were ascertained, of which 1023 (21%) had chronic kidney disease (CKD) and 235 were on dialysis (4.8% of all SCA; 23% of patients with CKD). Of the dialysis subgroup, 90 (94%) were on HD, and 6 (6%) on peritoneal dialysis. The on-dialysis group (n=49, 21%) was comprised of 37 (16%) with SCA during HD, and 12 (5%) within 1 hr post-HD. By chance alone, based on estimated weekly time on dialysis, only 6% of SCA events would be expected to be during dialysis (p&lt;0.001). The off-dialysis group (n=184) comprised the majority (79%) of SCA with history of dialysis. There were no significant differences in age, sex and race or BMI between the 2 groups. Conclusions: The prevalence of dialysis among total SCA cases was 24-fold higher than the general population on dialysis (0.2%), and risk was elevated &gt;3-fold during HD. These findings suggest potential opportunities for SCA prevention that could be explored in HD techniques as well as awareness and compliance with dialysis.
Abstract 13784: Recurrence of Major Adverse Cardiovascular Events Following Acute Coronary Syndrome: Outcomes From a Large Integrated Healthcare System
Authors: Timothy C Shuey, Stephen J Voyce, Alicia Johns, Braxton Lagerman, Alexis Gallagher, Shikhar Agarwal
Journal: Circulation (2022)

Introduction: We investigated recurrent events following acute coronary syndrome (ACS) at our large integrated healthcare system Methods: We performed a retrospective study of 4,898 patients treated for ACS within the Geisinger Health System between 2015-2021. Data was obtained via programmatic extraction from the electronic health record. The primary outcome was a composite of patients experiencing at least one major adverse cardiovascular event (MACE) in the follow-up period: ACS, coronary revascularization, or cerebrovascular. Descriptive statistics for MACE and prescription medications were performed. Results: Median length of time in the study was 2.6 years. Guideline directed medical therapies (GDMT) were &gt;95% for aspirin, beta-blockers and high intensity statin and 88% for P2Y12 inhibitors. Despite this high level of care, 970 (19.8%) patients met the composite primary outcome with an incidence of 11.8 events/100 patient-years. During the study period, 6.6% of patients experienced a subsequent ACS event, 13.7% underwent revascularization and 5.9% had a cerebrovascular event; 4.7% of patients experienced 2 or more MACE events during the follow-up period. Conclusions: This data shows that the incidence of recurrent MACE after an initial ACS remains high despite GDMT. Identification of patient characteristics portending elevated residual risk and institution of therapies directed at these patients requires further study.
Abstract 12815: High Throughput Variant Identification in the S3-S5 Helices of <i>KCNH2</i> (hERG)
Authors: Rizwan Ullah, Chai A Ng, Loren Vanags, Devyn Mitchell, Jamie Vandenberg, Brett Kroncke
Journal: Circulation (2022)

Introduction: LQTS is a multi-factorial cardiac repolarization disorder characterized by a prolonged corrected QT interval (QTc) that predisposes individuals to sudden death. Variants in KCNH2 account for ~30% of LQTS cases. Variants in a ‘hotspot’ domain of KCNH2 are of concern, as variant location in KCNH2 is strongly associated with increased risk of cardiac events. Here, we determined the trafficking phenotype of all possible variants in the S3 and S4 helices (Voltage sensor) and S5 helix and p-loop (pore domain), both ‘hotspot’ domains, of KCNH2 . Method: We used a HA tagged KCNH2 construct containing mCherry to enable massively parallel characterization of channel trafficking of missense KCNH2 variants. We studied a total of 3315/3381 possible variants for residues 477-637. Results: Our preliminary data revealed a heterogenous distribution of trafficking defects (range: 0-157% of WT). Some regions (e.g. 562-566) were largely intolerant to substitution (trafficking scores ~0% for all variants) whereas other regions (e.g. 509-521) were very permissive of substitution (trafficking ranged from 78-146% of WT). For 51 clinically identified variants, we compared trafficking results with peak tail current density data and found that 4/6 were correctly classified as functionally normal and 42/44 correctly classified as loss of function. Conclusion: Massively parallel trafficking assay can identify KCNH2 defects and illuminate important channel biophysics. Massively parallel trafficking assays will enable prospective and accurate variant assessment for any missense variant in KCNH2 and subsequently other proteins where misfolding is a major loss-of-function mechanism.
Abstract 13485: Sunitinib and Changes in Right Ventricular Function: Insights From a Prospective Cohort of Patients With Metastatic Renal Cell Carcinoma
Authors: Leah Rethy, Biniyam Demissei, Vivek Narayan, Naomi Haas, Bonnie Ky
Journal: Circulation (2022)

Introduction: Tyrosine kinase inhibitors (TKI) have established cardiotoxic effects including hypertension and declines in left ventricular ejection fraction (LVEF). However, the effects on right ventricular (RV) function remain unknown. Methods: Patients with metastatic renal cell carcinoma (mRCC) initiating sunitinib therapy were prospectively enrolled and echocardiography was performed at baseline and at 3.5, 15 and 33 weeks. All participants with ≥ 1 echocardiographic metric of RV function (FAC, TAPSE, RV S’) from ≥2 time points were included. Estimates of mean (95% CI) absolute change in RV function and associations between clinical characteristics and changes in RV function were calculated using generalized estimating equations. Results: Of the 84 patients included, 55% had prevalent hypertension, 51% had hypercholesterolemia, 5% had heart failure and 8% had coronary heart disease. Estimates for changes in RV function after 3.5 weeks were: -0.5% (-1.5, 0.5) for FAC, p=0.32; -0.05 cm (-0.08, -0.02) for TAPSE, p=0.002; and -0.8 cm/s (-1.2, -0.5) for RV S’, p&lt;0.001 (Figure). At 33 weeks, the decline in RV S’ remained significant (-1.8 cm/s [-2.6, -1.0], p&lt;0.001). Higher doses of sunitinib were associated with a decline in TAPSE (50mg vs. 25mg [reference]: -0.20cm [-0.33.-0.07]). TAPSE and RV S’ were associated with concurrent declines in LVEF (-2.2% [-3.5, -0.9]; -2.1% [-3.4, -0.8] for each interquartile decline in TAPSE and RV S’ respectively, p=0.001). There were no associations between changes in FAC and LVEF, and no clinical characteristics were associated with declines in FAC. Conclusions: In patients with mRCC, sunitinib treatment was associated with a modest worsening of RV function. Further study is needed to determine the longer term consequences of these changes.
Abstract 12816: Single High-Sensitivity Point of Care Whole Blood Cardiac Troponin I Measurement to Rule Out Acute Myocardial Infarction at Low Risk
Authors: Fred S Apple, Stephen W Smith, Jaimi Greenslade, Yader Sandoval, William Parsonage, Isuru Ranasinghe, Niranjan Gaikwad, Karen Schulz, Laura Stephensen, Christian Schmidt, Brynn Okeson, Louise Cullen
Journal: Circulation (2022)

Introduction: High-sensitivity cardiac troponin (hs-cTn) laboratory assays are used to rule out myocardial infarction (MI) on presentation, but prolonged result turn-around times can delay patient management. Hypothesis: Our aim was to identify patients at low risk of index MI using a rapid, point of care (POC), whole blood hs-cTnI assay at presentation, with potential early patient discharge, with &lt; 1% risk of adverse events. Methods: Consecutive emergency department patients from two prospective, observational studies with suspected acute coronary syndrome were enrolled. A POC hs-cTnI assay (Siemens Atellica ® VTLi) threshold using whole blood at presentation, that resulted in a negative predictive value (NPV) of ≥99.5% and sensitivity of &gt; 99% for index MI, was derived (SEIGE) and validated using plasma (SAMIE). Event adjudications were established using hs-cTnI assay results from usual clinical care. The primary outcome was MI at 30-days. Results: 1086 patients (8.1% MI) were enrolled in a US derivation cohort (SEIGE) and 1486 (5.5% MI) in an Australian validation cohort (SAMIE). A derivation whole blood POC hs-cTnI concentration of &lt;4ng/L provided a NPV of 99.5% (95% CI: 97.2-100%) and sensitivity of 98.9% (93.8-100%) for ruling out MI. In the validation cohort, NPV was 99.8% (99.1-100%) and sensitivity 98.8% (93.3-100%). 17.8% and 41.8%, respectively, were defined as low risk for discharge. 30-day adverse cardiac events were 0.1% (n=1) for SEIGE and 0.8% (n=5) for SAMIE. Conclusions: A point-of-care, whole blood hs-cTnI assay permits an accessible, rapid and safe exclusion of MI, and expedites discharge from the emergency department.
Abstract 13828: Improvement in Racial Disparities in Heart Transplantation Following the Heart Allocation Policy Change
Authors: Curry Sherard, Savannah Skidmore, Khaled Shorbaji, Brett Welch, Arman Kilic
Journal: Circulation (2022)

Objectives Heart allocation policy (HAP) in the US was changed in October 2018. The aim of this study was to assess the effect of the new policy on racial disparities in heart transplantation (HT) outcomes. Methods: The United Network for Organ Sharing (UNOS) registry was used to identify adult patients undergoing isolated HT between 2010-2021. Patients were stratified into pre-HAP (January 2010 to September 2018) vs. post-HAP (October 2018 to September 2021). Recipient race was classified as White, Black, Hispanic, or Other. The primary outcome was post-HT mortality. Cox proportional hazard models were used for risk-adjustment in evaluating the independent effect of race on mortality. Results A total of 27,403 patients underwent HT in 143 centers during the study period. The proportion of non-whites undergoing HT increased in the post-HAP era: (pre-HAP: White 66.0%, Black 21.2%, Hispanic 8.2%, Other 4.6% versus post-HAP: White 62.5%, Black 23.2%, Hispanic 9.5%, Other 4.8%; p&lt;0.001). In risk-adjusted analysis, Black recipients were at higher risk of post-HT mortality in the pre-HAP era (HR 1.31, 95% CI 1.22-1.41; p&lt;0.001) but not in the post-HAP era (HR 1.12, 95% CI 0.03-1.34; p=0.222) compared to White recipients. Other non-white recipients had comparable risk-adjusted post-HT mortality rates compared to White recipients both in the pre- and post-HAP eras. Conclusions: Under the new heart allocation system, a higher percentage of recipients are non-white. In addition, racial disparities in outcomes have improved with Black recipients no longer having an increased adjusted risk of mortality following HT.
Abstract 12963: Increased Readmission Rates in Cardiogenic Shock Patients Who Received Temporary Mechanical Circulatory Support: A Call to Targeted Action
Authors: Crystal An, Krish Dewan, Guangjin Zhou, Jean-Luc Maigrot, Siran Koroukian, Samantha Xu, Noha Eid, Edward G Soltesz, Aaron J Weiss
Journal: Circulation (2022)

Introduction: Patients hospitalized for cardiogenic shock who survive to discharge are at high risk of readmission. Patients requiring temporary mechanical circulatory support (tMCS) during their index admission reflect a high risk population. Therefore, we aim to quantify and compare the 90-day readmission trends for patients who did and did not receive tMCS at their index hospitalization for cardiogenic shock. Methods: From 2016 to 2019, patients with an admission diagnosis for cardiogenic shock were identified in the Florida State Inpatient Database. Patient characteristics, management at index admission, and causes of readmission were analyzed. Results: In total, 31,986 patients had an index admission for cardiogenic shock, of which 5,229 (16.3%) were treated with tMCS. In a 90-day cohort analysis of 18,317 patients, 6,119 (33.4%) patients were readmitted. Among patients that received tMCS during their index admission, 1,583 (51.2%) were readmitted compared with 4,536 (29.8%) that did not receive tMCS. Repeat readmissions for cardiogenic shock were present in 490 (15.9%) of patients who received tMCS at index admission compared with 232 (1.5%) of patients who did not have tMCS at index hospitalization. There was no statistically significant difference in the readmission rates across the four years of the study. Conclusions: Despite significant improvements in medical therapy and mechanical support in recent years, the rate of readmission after index admission for cardiogenic shock has not decreased. Trends in 90-day readmission demonstrate that patients who received tMCS at their index hospitalization for cardiogenic shock were not only more likely to be readmitted, but also more likely to be readmitted specifically with a repeat diagnosis of cardiogenic shock. Patients who require tMCS at their index admission for cardiogenic shock should be targeted as a high risk group to prevent readmission.
Abstract 13918: Combined ECG Precordial Voltage and Troponin-T in Stress Cardiomyopathy versus Anterior STEMI
Authors: Ushma V Majmudar, Fengwei Zou, Li Pang, Parth Pancholi, Aldo L Schenone, DMITRIY NEVELEV, Mario J Garcia
Journal: Circulation (2022)

Introduction: Stress cardiomyopathy (SC) and anterior ST elevation myocardial infarction (AMI) share similar clinical and echocardiographic features on initial presentation, complicating their differentiation. Previously, subtle differences in 12-lead ECG between the two have been reported. Hypothesis: We propose that higher precordial R-wave amplitude on ECG and lower biomarkers values can serve as reliable predictors of SC during initial triage. Methods: Among patients admitted to a single center from 2015-2019 undergoing left heart catheterization (LHC) for suspected AMI, 76 patients with either LHC-proven SC or AMI (38 each) were included. All patients had transthoracic echocardiography (TTE) performed within 24 hours of LHC. Patients were excluded when TTE quality was poor. Left ventricular ejection fraction (LVEF) and speckle-tracking global longitudinal strain (GLS) were calculated from transthoracic apical views. Non-parametric variables were analyzed using Wilcoxon rank sum test. Sensitivity and specificity analyses were performed using ROC curves. Results: LVEF (33 + 9% vs 33 + 8%) and GLS (-7.5 + 2.8% vs -7.9 + 3.3%) were similar in both groups. R-wave amplitude in ECG leads V1-V2 was higher in SC compared to AMI (V1: 0.96 vs 0.54 mV, p = 0.035; V2: 1.46 vs 0.75 mV, p = 0.037). At index admission, peak pro-BNP was higher (22198 vs 3098, p = 0.002) and peak Troponin-T (1.43 vs 236, p &lt;0.001) was lower in SC. Integrating peak Troponin-T and V1+V2 R-wave amplitudes differentiated SC from AMI with sensitivity = 92% and specificity = 73%. Conclusions: Despite having similar extent of LV systolic dysfunction when compared to AMI patients, SC patients have lower troponin elevation and R-wave amplitude reduction at presentation. These characteristics may be useful for selecting patients who do not require urgent invasive diagnostic evaluation.